Massachusetts is the latest state to lift restrictions on hepatitis C virus (HCV) treatment under its Medicaid program. Thanks to legal battles and lobbying efforts, restrictive policies on HCV treatment across the country are under pressure.

The Massachusetts expansion follows a threatened lawsuit by the state’s attorney general against hep C drugmakers Gilead Sciences, AbbVie and Merck that induced the pharmaceutical companies to offer the state bigger rebates. As a result, the state can now afford to treat all its HCV-positive beneficiaries, not just those with advanced liver disease.

Florida, New York, Washington state and Delaware also have made similar moves to expand access to hep C treatment in their Medicaid programs. Commercial insurers such as Anthem Inc. and United HealthCare have done the same. Many have done so under the threat of legal action from advocates and in response to political pressure.

Many states are struggling to set aside big enough budgets to keep up with demand. However, advocates argue that the up-front cost of treatment for all is likely to save insurers millions of dollars in long-term care.